全凭静脉麻醉与静吸复合麻醉对重症颅脑创伤患者血流动力学及IL-6、ADR、NADR水平的影响

Effects of total intravenous anesthesia and combined intravenous-inhalation anesthesia on hemodynamics and IL-6,ADR,NADR levels in patients with severe traumatic brain injury

目的 分析予以重症颅脑创伤患者全凭静脉麻醉与静吸复合麻醉对其血流动力学、白细胞介素-6(IL-6)、肾上腺素(ADR)及去甲肾上腺素(NADR)水平的影响。方法 68例重症颅脑创伤患者为研究对象,采用随机数表法分成对照组和观察组,各34例。对照组予以静吸复合麻醉,观察组予以全凭静脉麻醉。比较两组术后恢复情况(苏醒时间、拔管时间、恢复自主呼吸时间),不同时间点[麻醉前(T_(0))、切皮时(T_(1))、切硬脑膜时(T_(2))、术后24 h(T_(3))]的血流动力学指标[平均动脉压(MAP)、心率(HR)]、应激指标(ADR、NADR)、炎症指标(IL-6)水平。结果 观察组的苏醒时间(6.20±0.78)min、拔管时间(8.45±1.65)min短于对照组的(9.62±1.14)、(12.35±2.14)min,差异具有统计学意义(P<0.05)。观察组T_(1)、T_(2)时的HR、MAP、ADR、NADR、IL-6水平低于对照组,差异具有统计学意义(P<0.05)。结论 和静息复合麻醉相比,予以重症颅脑创伤患者全凭静脉麻醉对其术中血流动力学的影响更小,能减轻炎症及应激反应,促进患者术后恢复。

Objective To analyze the effects of total intravenous anesthesia and combined intravenousinhalation anesthesia on hemodynamics and interleukin-6(IL-6),adrenaline(ADR),noradrenaline(NADR)levels in patients with severe traumatic brain injury.Methods A total of 68 patients with severe traumatic brain injury were studied and divided into control and observation groups according to random numerical table,with 34 cases in each group.The control group received combined intravenous-inhalation anesthesia,and the observation group received total intravenous anesthesia.Both groups were compared in terms of postoperative recovery(wake-up time,extubation time,recovery time of spontaneous breathing),hemodynamic indicators[mean arterial pressure(MAP),heart rate(HR)],stress indicators(ADR,NADR),inflammation indicators(IL-6)levels at different time points[before anesthesia(T_(0)),at the time of skin incision(T_(1)),at the time of dural incision(T_(2)),24 h after surgery(T_(3))].Results The wake-up time(6.20±0.78)min and the extubation time(8.45±1.65)min of the observation group were shorter than(9.62±1.14)and(12.35±2.14)min of the control group,and the difference was statistically significant(P<0.05).The levels of HR,MAP,ADR,NADR,and IL-6 in the observation group at T_(1) and T_(2) were lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion Compared with combined intravenous-inhalation anesthesia,total intravenous anesthesia has less impact on intraoperative hemodynamics of patients with severe traumatic brain injury,and it can reduce the inflammation and stress response,and promote postoperative recovery of patients.